Video-based assessments of activities of daily living: generating real-world evidence in pediatric rare diseases

Video-based Clinical Outcome Assessments (vCOAs) are poised to revolutionize the management of pediatric rare diseases by providing a more accurate, engaging, and patient-centered approach to monitoring and evaluating treatment outcomes. These methods will become more integrated and essential in clinical trials and everyday care.

In this paper, our authors explore the advantages of vCOAs, the requirements for their implementation and validation, and what the future may hold for further vCOA development.

Abstract

Introduction

Preserving function and independence to perform activities of daily living (ADL) is critical for patients and carers to manage the burden of care and improve quality of life. In children living with rare diseases, video recording ADLs offer the opportunity to collect the patients’ experience in a real-life setting and accurately reflect treatment effectiveness on outcomes that matter to patients and families.

Areas covered

We reviewed the measurement of ADL in pediatric rare diseases and the use of video to develop at-home electronic clinical outcome assessments (eCOA) by leveraging smartphone apps and artificial intelligence-based analysis. We broadly searched PubMed using Boolean combinations of the following MeSH terms ‘Rare Diseases,’ ‘Quality of Life,’ ‘Activities of Daily Living,’ ‘Child,’ ‘Video Recording,’ ‘Outcome Assessment, Healthcare,’ ‘Intellectual disability,’ and ‘Genetic Diseases, Inborn.’ Non-controlled vocabulary was used to include human pose estimation in movement analysis.

Expert opinion

Broad uptake of video eCOA in drug development is linked to the generation of technical and clinical validation evidence to confidently assess a patient’s functional abilities. Software platforms handling video data must align with quality regulations to ensure data integrity, security, and privacy. Regulatory flexibility and optimized validation processes should facilitate video eCOA to support benefit/risk drug assessment.


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The Impact of Video Electronic Outcome Assessments (vCOAs)

Unlock the power of video assessments in your clinical operations with our comprehensive white paper, “From Clinical Visits to Remote Assessments: The Impact of Video Electronic Outcome Assessments (vCOAs).”

This guide explores the use of video Clinical Outcome Assessments (vCOAs), a transformative subset of eCOAs, offering clinical operations teams the tools to capture real-world data more effectively.


In this white paper, you will learn

  1. How vCOAs leverage patients’ own devices to perform tasks and assessments, enhancing data accuracy and reducing biases with automated data analyses.
  2. The benefits of remote video assessments, making trials more inclusive and reducing the need for patients to travel, minimising stress and increasing participation.
  3. The capabilities of real-time tracking and AI-driven analytics in providing immediate, actionable insights, improving the quality and effectiveness of clinical studies.

Three Reasons to Download this White Paper

1. Innovative Trial Design: Gain insights into how vCOAs can invigorate clinical trial designs by enabling remote video assessments and incorporating real-time data analysis.

2. Operational Efficiency: Discover how the automation of vCOAs reduces the burden on clinical staff, streamlines quality control, and ensures high standards of data privacy and security.

3. Improved Patient Outcomes: Learn how continuous and precise monitoring through vCOAs can enhance patient safety, improve treatment outcomes, and provide a more comprehensive understanding of patient health during trials.

Download our white paper and empower your clinical operations team with the knowledge to implement effective, scalable, and patient-centric video eCOAs.

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How to Meet Regulatory & Compliance Requirements for Capturing eCOAs in Clinical Trials

How to Meet Regulatory & Compliance Requirements for Capturing eCOAs in Clinical Trials provides in-depth insights into adapting to the evolving landscape of clinical trials technology.

We highlight the integration of Electronic Data Capture (EDC) platforms, Machine Learning, and AI in clinical management to ensure audit readiness and compliance with the latest FDA and EMA guidelines. Explore the transition from traditional Computer System Validation (CSV) to a more dynamic Computer System Assurance (CSA), focusing on risk-based approaches and minimizing extensive documentation.

In this white paper you will learn:

  1. Transitioning from CSV to CSA. Understand the shift from traditional CSV to the more dynamic CSA. Learn about the FDA’s latest guidelines which emphasize risk-based approaches, reduce the burden of documentation, and ensure the security, availability, and reliability of clinical trial systems.
  2. Adapting to New Regulatory Requirements. Discover how recent regulatory changes impact the management and execution of clinical trials, specifically the integration of Machine Learning and Artificial Intelligence in clinical trial management, and how these technologies meet FDA and EMA standards for data integrity and reliability.
  3. Implementing a Robust eQMS with AMP™. Explore how the Aparito Management Platform (AMP™) streamlines your operations, integrates risk management and ensures data integrity across every aspect of your study, keeping you audit-ready and compliant in a complex regulatory environment.

Download the white paper today to ensure your team is equipped with the knowledge to implement effective and compliant eCOA strategies in your clinical trials. Transform your processes, meet regulatory demands, and stay ahead in the fast-evolving world of clinical research.

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On-demand webinar: Why vCOAs are the Greatest Value Unlock in Clinical Trials

Our webinar on the transformative potential of Video Clinical Outcome Assessments (vCOA) in real-world studies is now available for on-demand viewing!

This webinar is a must-watch for clinicians, researchers, and healthcare professionals seeking to leverage the latest advancements in digital health technology to improve patient outcomes and deepen their understanding of disease progression through innovative assessment tools.

🔍 Discover the Future of Patient Data Capture with vCOA

The webinar offers an in-depth exploration of how vCOA transforms the way patient data is captured, ensuring consistency across remote and in-person assessments. We spotlight the development and validation of the video Timed Up-and-Go (vTUG) assessment within our Atom5™ eCOA platform, a collaboration with DZNE, highlighting its pivotal role in enhancing patient care and research methodologies.

💡 What You Will Learn

1. Validation of Video-Based Outcome Assessments 

Gain insights into our rigorous process for validating the usability and feasibility of video-based assessments, ensuring they meet high standards of accuracy and reliability.

2. Real-World Deployment of vTUG for Parkinson’s Disease

Discover how integrating vTUG into everyday practice is transforming the follow-up of patients with Parkinson’s Disease, enabling continuous, real-world monitoring that captures the nuances of disease progression.

3. Automated Video Analysis for Enhanced Clinical Insights

Learn about the cutting-edge automated analysis of video recordings, which provides more reliable and objective measurements. This technology assists clinicians by introducing new metrics for evaluation and offers unprecedented insight into the progression of diseases.

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Measuring What Matters with eCOAs: A New Era of Patient-Led Innovation

In the evolving landscape of healthcare and clinical research, the traditional methodologies of assessing patient outcomes are undergoing a significant transformation thanks to the advent of electronic Clinical Outcome Assessments (eCOAs), marking a pivotal shift from conventional paper-based methods, offering myriad benefits that enhance the accuracy, efficiency, and inclusivity of clinical trials.

eCOAs promise enhanced data quality through direct source capture, real-time access for faster decision-making, and improved patient engagement through user-friendly interfaces. These advancements are not just about improving methods; they reflect a deeper commitment to patient-centred research and a push towards more rigorous, evidence-based practices in drug development.

In this white paper you will learn:

  1. How eCOAs boost data collection by enhancing data quality, patient participation, and efficiency in clinical research.
  2. The role of eCOAs in enabling diverse participants to join clinical research, breaking down barriers for those with limited access to traditional study sites.
  3. An overview of the expanded categories of COAs, including the latest FDA-guided developments, and how digital technologies are reshaping the way health outcomes are measured and analyzed

With examples like the SARAhome for ataxia and DMDhome for Duchenne Muscular Dystrophy, the paper illustrates the potential of eCOAs to capture nuanced changes in patient conditions and treatment impacts, offering a richer, more detailed view of patient experiences.

Moreover, the development of novel eCOAs and the digitisation of existing ones underscore the flexibility and adaptability of electronic assessments to meet the evolving needs of clinical research.

Download the full white paper to explore the transformative potential of eCOAs and discover how they are reshaping clinical trials.

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Recommendations to address respondent burden associated with PROs

Patient-reported outcomes (PROs) are crucial in healthcare research, offering insights into interventions from the patient’s perspective. This study focuses on mitigating respondent burden in #PROs to enhance data quality and decision-making.

After a thorough literature review and a Delphi survey involving multi-stakeholders, the authors compiled 19 recommendations to address this issue including “where possible, consider the use of ePROs, which may help reduce respondent burden, but must be balanced with the needs and preferences of the target population” and “explore the functionality of ePROs with diverse representatives from the target population where possible”.

Abstract

Patient-reported outcomes (PROs) are increasingly used in healthcare research to provide evidence of the benefits and risks of interventions from the patient’s perspective and to inform regulatory decisions and health policy. PROs in clinical practice can facilitate symptom monitoring, tailor care to individual needs, aid clinical decision-making, and inform value-based healthcare initiatives. Despite their benefits, there are concerns that the potential burden on respondents may reduce their willingness to complete PROs, with a potential impact on the completeness and quality of the data for decision-making. We therefore conducted an initial literature review to generate a list of candidate recommendations aimed at reducing respondent burden.

A two-stage Delphi survey by an international multi-stakeholder group followed this. A consensus meeting was held to finalize the recommendations. The final consensus statement includes 19 recommendations to address PRO respondent burden in healthcare research and clinical practice. If implemented, these recommendations may reduce PRO respondent burden.


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A patient-centred and multi-stakeholder co-designed observational prospective study protocol: Example of the adolescent experience of treatment for X-linked hypophosphataemia (XLH)

In “A patient-centred and multi-stakeholder co-designed observational prospective study protocol: Example of the adolescent experience of treatment for X-linked hypophosphataemia (XLH)”, a diverse team of expert physicians, researchers, technology specialists, patients, and caregivers came together to co-design a prospective observational study on XLH, a rare disease affecting adolescents.

This protocol adds to the evidence that keeping patients at the heart of research design is crucial for generating robust and meaningful data.

Abstract

The importance of patient centricity and keeping the patient at the heart of research design is now well recognised within the healthcare community. The involvement of patient, caregiver and clinician representatives in the study design process may help researchers to achieve this goal and to ensure robust and meaningful data generation.

Real-world data collection allows for a more flexible and patient-centred research approach for gaining important insights into the experience of disease and treatments, which is acutely relevant for rare diseases where knowledge about the disease is more likely to be limited.

Here, we describe a practical example of a patient-centric, multi-stakeholder approach that led to the co-design of a prospective observational study investigating the lived experience of adolescents with the rare disease, X-linked hypophosphataemia. Specifically, we describe how the knowledge and expertise of a diverse research team, which included expert physicians, research and technology specialists, patients and caregivers, were applied in order to identify the relevant research questions and to ensure the robustness of the study design and its appropriateness to the population of interest within the context of the current clinical landscape.

We also demonstrate how a structured patient engagement exercise was key to informing the selection of appropriate outcome measures, data sources, timing of data collection, and to assessing the feasibility and acceptability of the proposed data collection approach.


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Enhancing Global Studies with Commercial-Grade Wearable Data

Wearable devices (wearables) are a rich source of health-related data that can help accelerate study timelines, reduce participant burden, generate novel insights, and make faster, better-informed clinical decisions based on high-quality, real-world evidence.

The use of wearables in real-world studies has seen significant growth, with analysts predicting that 70% of clinical trials will incorporate wearable devices by 2025. Clinicaltrials.gov reports approximately 1,500 trials currently using wearables, with over 700 completed as of August 2023.

Commercial-grade wearables have the potential to transform clinical trials, enabling efficient and cost-effective remote monitoring. They have been successfully used to monitor wearing-off symptoms in Parkinson’s Disease patients and have shown excellent accuracy compared to gold standards in cardiovascular disease assessment.

But how do you select a wearable, which measurements should you choose, and how do you go about operationalising a study using wearables?

Aparito has gained valuable experience implementing consumer wearables in global studies and understanding both the opportunities and challenges they present.

In this white paper, we share:

  1. our work utilising commercial-grade wearables in global studies with 3000 patients enrolled across two dozen countries spanning EMEA, AMER and APAC
  2. the myriad choices one must navigate to select the right wearable device considering factors such as data accuracy, device compatibility, and participant acceptance
  3. what’s next for wearable devices in clinical trials of the future?

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Pixels or paper? Exploring Patient-Reported Outcomes (PROs) in Clinical Trials

Paper-based patient-reported outcomes (pPROs) remain a popular means of data collection in clinical trials due to their lower setup costs when compared to electronic PROs (ePROs), although the cost-saving benefits of ePROs rapidly eclipse the initial savings made through pPROs. Furthermore, compliance rates for ePROs range from 90% to 97%, compared to the 30% or lower compliance rate seen for pPROs.

The US Food and Drug Administration (FDA) has made it clear that electronic capture of clinical trial source data over paper-based data collection is the preferred option.

It has been almost a decade since the FDA made their preferences known, so why do sponsors and contract research organisations (CROs) continue to choose pPROs, when the evidence suggests that ePROs are cheaper and more effective in the long term?


In this white paper, we explore why pPROs prevail despite their shortcomings and why ePROs will continue their increasing adoption as their benefits become clearer.

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Video-Based Assessments to Digitize COA: validating vTUG for Parkinson’s disease

We are pleased to announce the completion of recruitment for our study to validate the video Timed Up-and-Go (vTUG) as a means of monitoring Parkinson’s disease (PD) patients’ gait and balance at home.

Close monitoring of the disease in each patient is an approach that enabled us to develop the vTUG, an eCOA where weekly assessments provide a more meaningful measure of gait and balance than a conventional snapshot visit conducted once a year.

This study aims to validate the usability and feasibility of digital outcome assessments and the development of remote endpoints to follow up with patients living with PD, including progression of the disease, treatment effects and balance and, possibly testing the effect of new drugs within drug trial boundaries.


In this white paper, we explore the deployment of vTUG into the real world and how it enables follow-up of patients living with PD in their everyday lives.

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